Microcephaly (Infant with small head)

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History:

HIE / neonatal seizures or other complications?

Significant illness in early infancy? Sepsis / meningitis?

Any neurological symptoms? Seizures, stiffness, feeding issues?

Symptoms of raised ICP?

Any developmental delay? Regression?

 

Maternal / Birth / Family:

– Illnesses / trauma in pregnancy? 

  TORCH? Hypothyroid?

– Teratogenics 

  (medications, alcohol, recreational drugs)

– Malnutrition? 

  Placental insufficiency? IUGR?

 

Family h/o genetic or neurodevelopment disorder?

Examination:

– Trend of serial HC

–  Head shape- symmetrical?

– Sutures palpable?

– Fontanelle open / absent?

– Dysmorphism / malformations?

  esp. eyes, palate, spine

Full Neuro exam

– Tone- low / increased?

– Spasticity / dystonia?

– Traits of ASD / ADHD?

Investigations:

– Microarray (genetics) esp if 

  dysmorphisms / malformations / 

  severe microcephaly / LD

– MRI Brain esp if 

  neurological features i.e. 

  seizures, spasticity or regression

– TORCH screen 

  (only if suspecting cong infn in young child)

– Neuro-metabolic tests

  (selectively)

– CT Head if suspecting

  craniosynostosis / TORCH

Management:

– Support development

– Treat spasticity, seizures

– Therapy services as required

– Extra support in school

 

Consider referrals:

– Opthal

– Genetics

– Neurosurgery

– other